Provider Demographics
NPI:1821372293
Name:PROGRESSIVE REHABILITATION GROUP, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE REHABILITATION GROUP, INC.
Other - Org Name:NEW PARADIGM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOBER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:509-429-3355
Mailing Address - Street 1:201 E ANSEL AVE
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98812-9609
Mailing Address - Country:US
Mailing Address - Phone:509-429-3355
Mailing Address - Fax:
Practice Address - Street 1:1 COULEE BLVD WEST
Practice Address - Street 2:
Practice Address - City:ELECTRIC CITY
Practice Address - State:WA
Practice Address - Zip Code:99123
Practice Address - Country:US
Practice Address - Phone:509-429-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008835305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization